Autoresuscitation of Poloxamer 188 in Pigs With Traumatic Severe Hemorrhage.

BACKGROUND

Poloxamer 188 (P188) is a copolymer surfactant with plasma membrane stabilizing action. This study investigated the effects of P188 on blood volume and coagulation in pigs after traumatic hemorrhage and hypotensive resuscitation.

METHODS

Femur fracture was performed in 17 anesthetized pigs, followed by hemorrhage of 55% of estimated blood volume and a 10 min shock period. Afterwards, pigs were randomized to be resuscitated with either normal saline (n = 9, 4 mL/kg, NS group) or P188 (n = 8, 1.33 mL/kg at 150 mg/mL, plus 2.67 mL NS/kg, P188 group). Pigs were monitored for 2 h or until death. Hemodynamics were recorded and blood samples were taken at baseline (BL), after hemorrhage, shock, resuscitation, and at 2 h for blood and coagulation analysis using Rotem®.

RESULTS

All but one pig in each group survived to 2 h. Femur fracture and hemorrhage reduced mean arterial pressure to half of the BL and elevated heart rate to double of the BL (both P < 0.05). Resuscitation with NS or P188 did not return these measurements to BL. Compared to NS, resuscitation with P188 resulted in a smaller reduction of blood volume (76 ± 3% in P188 and 60 ± 2% in NS); higher base excess (3.3 ± 0.9 vs. 0.5 ± 0.9 mM); and lower hematocrit (24 ± 1 vs. 28 ± 1%) and Ca++ (24 ± 1 vs. 28 ± 1 mM). Resuscitation with P188 prolonged aPTT (43 ± 12 vs. 22 ± 3 s, all P < 0.05).

CONCLUSIONS

Following traumatic hemorrhage and hypotensive resuscitation, P188 improved circulation volume and base deficit, but induced slower clotting initiation in pigs. Thus, P188 may have limited benefit as an initial small volume resuscitation adjunct following hemorrhage.